Suture anchor and related method

ABSTRACT

A method and apparatus for securing soft tissue to bone can include loading a suture through an eyelet of a suture anchor. The suture anchor can have a longitudinal axis and a distal tip. An anchor inserter assembly can be positioned in contact with the suture anchor. The anchor inserter assembly can include a sleeve portion and an impacting portion. The suture can be engaged with a suture engaging member on the suture inserter assembly at a location adjacent to the eyelet. The sleeve portion can be translated relative to the impacting portion from an alignment position to an insertion position thereby moving the suture a first distance offset from the eyelet in a direction away from the distal tip. The anchor insert assembly can be advanced to a driven position thereby advancing the suture anchor into the bone. The suture engaging member can be released from the suture.

RELATED APPLICATIONS

This application claims the benefit of priority from U.S. ProvisionalApplication No. 61/843,660, filed Jul. 8, 2013, which is incorporated byreference herein in its entirety.

FIELD

The present disclosure relates generally to an apparatus and method foruse in orthopedic surgical procedures. More particularly, the presentdisclosure relates to a suture anchor system and method for securingsoft tissue, tendons and ligaments to bone during orthopedic surgicalprocedures.

BACKGROUND

The background description provided herein is for the purpose ofgenerally presenting the context of the disclosure. Work of thepresently named inventors, to the extent it is described in thisbackground section, as well as aspects of the description that may nototherwise qualify as prior art at the time of filing, are neitherexpressly nor impliedly admitted as prior art against the presentdisclosure.

Surgical or medical procedures are often performed on a body, forexample, a human body or anatomy, to repair or replace various portionsthereof. For example, the soft tissues of the body may need to bereattached to bones due to trauma, overuse, surgical intervention, ordisease. Soft tissue can be reattached to bone using devices such asscrews, staples, and various types of suture anchors. One means to fixthe soft tissue to the selected area is to provide a suture through aselected portion of the soft tissue and fix the other end of the sutureto a selected area on the bone using a suture anchor and a pre-formedhole in the bone, which can require various different instruments andtying a knot to secure the suture to the anchor. Accordingly, there is aneed for improvement in the relevant art.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

A method for securing soft tissue to bone can include loading a suturethrough an eyelet of a suture anchor. The suture anchor can have alongitudinal axis and a distal tip. An anchor inserter assembly can bepositioned in contact with the suture anchor. The anchor inserterassembly can include a sleeve portion and an impacting portion. Thesuture can be engaged with a suture engaging member on the sutureinserter assembly at a location adjacent to the eyelet. The sleeveportion can be translated relative to the impacting portion from analignment position to an insertion position thereby moving the suture afirst distance offset from the eyelet in a direction away from thedistal tip. The anchor insert assembly can be advanced to a drivenposition thereby advancing the suture anchor into the bone. The sutureengaging member can be released from the suture.

According to additional features, a desired amount of tension can beapplied on the suture subsequent to translating the sleeve portion. Thesuture anchor can be advanced into the bone a second distance. The firstand second distances can be substantially equivalent such that thedesired amount of tension on the suture is substantially constant fromthe insertion position to the driven position. In one example, thesleeve portion can be threadably advanced relative to the impactingportion. Translating the sleeve portion can cause the suture engagingmember to slidably engage the suture while the suture engaging membermoves from the alignment position to the insertion position, in thealignment position, a hook of the suture engagement member is alignedwith the eyelet.

In other features, releasing the suture engaging member can includerotating the sleeve relative to the impacting portion around alongitudinal axis of the anchor inserter assembly. Engaging the suturewith the suture engaging member can include engaging a first portion ofthe suture extending out of one side of the eyelet with the sutureengaging member. A desired amount of tension on the suture can beconfirmed on a portion of the suture extending out of an opposite sideof the eyelet. Advancing the suture anchor into the bone can includeimpacting an impacting plate on the impacting portion. The impacting cancause an impacting force to be transferred from the impacting portion tothe suture anchor. Positioning the anchor inserter assembly can includeadvancing a proximal stem of the suture anchor into a blind bore of theimpacting portion. A terminal proximal end of the proximal stem can becontacted with an engaging surface of the blind bore,

A suture securing assembly for use in securing a suture relative to bonecan include an impacting portion, a sleeve portion and an anchor. Theimpacting portion can extend along a first longitudinal axis. Theimpacting portion can have a strike plate and a shaft portion thatdefines a suture anchor engaging surface. The sleeve portion can bemovably coupled to the impacting portion. The sleeve portion can have acentral passage that receives the impacting portion therethrough. Thesleeve portion can have a suture engaging member formed at a distal end.The anchor can have an anchor body that includes a distal tip portionand an impactor engaging surface. The anchor body can define an eyelet.The proximal stem portion can be configured to be slidably received bythe suture anchor engaging surface. The sleeve portion can be configuredto translate relative to the impacting portion along the firstlongitudinal axis from an alignment position where the suture engagingmember is aligned with the eyelet to an insertion position where thesuture engaging member moves the suture to a location offset a distancefrom the eyelet in a direction away from the distal tip.

According to additional features, the sleeve portion can be threadablycoupled to the impacting portion. Rotation of the sleeve portion aboutthe first longitudinal axis can cause the sleeve portion to translaterelative to the impacting portion. The suture engaging member cancomprise a hook. The strike plate can be configured to engage the sleeveportion at the insertion position thereby inhibiting further relativetranslation of the sleeve portion and the impacting portion. The anchorbody can include a solid anchor portion and a porous anchor portion. Theeyelet can be defined by the solid anchor portion.

A suture anchor for securing a suture relative to bone can include ananchor body that extends along a longitudinal anchor body axis. Theanchor body can include a distal tip portion and a proximal bodyportion. The anchor body can define an eyelet. The anchor body canfurther comprise a solid anchor portion and a porous anchor portionwherein the eyelet is defined by the solid anchor portion.

According to additional features, the anchor body can further comprise afirst and a second longitudinal opening extending from a proximalterminal end surface of the anchor body to the eyelet. The first andsecond longitudinal openings can be defined by the solid anchor portion.The first and second longitudinal openings can be parallel to thelongitudinal anchor body axis. In one example, the anchor body caninclude at least one flexible wing portion extending outwardly from theanchor body. The flexible wing portion can be configured to contractduring insertion into bone and provide a radially outwardly biasingforce onto surrounding bone subsequent to insertion.

According to still other features, the eyelet can be formed through theanchor body from a first opening at the proximal terminal end surface ofthe anchor body to a second opening through an outer cylindrical wall ofthe anchor body. First and second flexible wings can be formed ondiametrically opposed portions the suture anchor. The first opening canbe defined through the first flexible wing.

According to yet other features, an insertion tool can selectively andremovably couple with the suture anchor for driving the suture anchorinto bone. The insertion tool can comprise a distal tip that selectivelykeys with a central opening of the anchor body. The distal tip candefine longitudinal slits formed therealong that are configured topermit suture to pass through. The distal tip can create a friction fitwith the central opening of the anchor body. The distal tip can includeat least one of an increased outer diameter portion and an o-ring.

Further areas of applicability of the present disclosure will becomeapparent from the description provided hereinafter. The description andspecific examples in this summary are intended for purposes ofillustration only and are not intended to limit the scope of the presentdisclosure.

DRAWINGS

The present teachings will become more fully understood from thedetailed description, the appended claims and the following drawings.The drawings are for illustrative purposes only and are not intended tolimit the scope of the present disclosure.

FIG. 1 a perspective view of a suture anchor constructed in accordanceto one example of the present disclosure;

FIG. 2 is a cross-sectional view of the suture anchor taken along lines2-2 of FIG. 1 ;

FIG. 3 is a side view of an exemplary flexible member securing assemblyin accordance with various aspects of the present disclosure and shownin an alignment position cooperating with a suture and the suture anchorof FIG. 1 ;

FIG. 4 is a cross-sectional view of the flexible member securingassembly taken along lines 4-4 of FIG. 3 ;

FIG. 5 is a side view of the flexible member securing assembly of FIG. 3and shown in an insertion position;

FIG. 6 is a side view of the flexible member securing assembly of FIG. 5and shown in a driven position subsequent to driving the suture anchorinto bone;

FIG. 7 is a side view of the flexible member securing assembly of FIG. 6shown with a sleeve portion rotated to free an end of the suture anchorfrom a suture engaging portion on the sleeve portion;

FIG. 8 is a partial exploded perspective view of a suture anchor andinsertion tool constructed in accordance to additional features of thepresent disclosure;

FIG. 9 is a cross-sectional view of a suture anchor constructed inaccordance to additional features of the present disclosure;

FIGS. 10-11 depict an exemplary method of using a primary and secondarysuture anchor according to the present disclosure;

FIG. 12 is a perspective view of another suture anchor constructed inaccordance to additional features of the present disclosure;

FIG. 13 is a cross-sectional view taken along lines 13-13 of the sutureanchor of FIG. 12 ;

FIG. 14 is a side view of an exemplary insertion tool constructed inaccordance to one example of the present disclosure;

FIG. 15 is a side view of an inserter tip constructed in accordance toadditional features;

FIG. 16 is a side view of another inserter tip constructed in accordanceto further features of the present disclosure; and

FIG. 17 is a side view of another inserter tip constructed in accordanceto additional features of the present disclosure.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, its application, or uses.Although the following description is related generally to methods andapparatus for securing a flexible member to bone, it should beappreciated that the methods and apparatus discussed herein can beapplicable to various bones and/or joints of the anatomy and can beutilized with various flexible members and rigid bodies or anchors.

Exemplary embodiments are provided so that this disclosure will bethorough, and will fully convey the scope to those who are skilled inthe art. Numerous specific details are set forth such as examples ofspecific components, devices, systems and/or methods, to provide athorough understanding of exemplary embodiments of the presentdisclosure. It will be apparent to those skilled in the art thatspecific details need not be employed, that exemplary embodiments may beembodied in many different forms and that neither should be construed tolimit the scope of the disclosure. In some exemplary embodiments,well-known processes, well-known device structures, and well-knowntechnologies are not described in detail.

The present teachings provide a flexible member securing assembly and amethod for using the same to secure a flexible member to bone. In anexemplary aspect, the flexible member can be a suture and the rigid bodycan be an anchor. In an exemplary aspect, the flexible member securingassembly can include an impacting portion and a sleeve portion movablycoupled to each other and provided preassembled in a kit. In anotherexemplary aspect, the kit can further include an anchor. The presentteachings further disclose various alternate insertion tools that areselectively and removably coupled to the anchor.

With initial reference to FIGS. 1-7 , a suture anchor constructed inaccordance to one example of the present disclosure is shown andgenerally identified at reference numeral 10. The suture anchor 10 canbe provided together such as in a kit with an inserter assembly 12 as asuture securing assembly 14. As will become appreciated from thefollowing discussion, the inserter assembly 12 can cooperate with thesuture anchor 10 and be used to drive the suture anchor 10 into bone.While the suture anchor 10 and inserter assembly 12 will be describedherein as cooperating as a suture securing assembly 14, it will beappreciated that the suture anchor 10 and the inserter assembly 12 canbe used separately. In this regard, the suture anchor 10 can be usedwith other inserter assemblies while the inserter assembly 12 can beused to drive other suture anchors into bone.

With particular reference to FIGS. 1 and 2 , the suture anchor 10 willbe further described. The suture anchor 10 generally comprises an anchorbody 20 that extends along a longitudinal anchor body axis 22. Theanchor body 20 can include a distal tip portion 24, a proximal bodyportion 26 and an impactor engaging surface or proximal stem portion 28.An eyelet 30 can be formed through the proximal body portion 26. In theexample shown, the eyelet 30 has a substantially oval shape; however,other configurations are contemplated. As will become appreciated fromthe following discussion, the eyelet 30 can be used during knotlesssuture fixation.

The anchor body 20 can include a solid anchor portion 32 and a porousanchor portion 34. In the example shown, the porous anchor portion 34can have a nesting porous portion 36, an intermediate porous portion 38and a proximal porous portion 40. The nesting porous portion 36 can beformed generally intermediate the distal tip portion 24 and the eyelet30. The intermediate porous portion 38 can be formed generally aroundthe eyelet 30. The proximal porous portion 40 can be formed generallyproximal of the eyelet 30. In the example shown, the eyelet 30 is formedexclusively by the solid anchor portion 32. In one example, the solidanchor portion 32 can have a wall thickness 42 (FIG. 2 ) at the eyelet30 of at least 0.5 mm and preferably between 0.5 mm and 0.75 mm. Otherconfigurations are contemplated. The solid anchor portion 32 that formsthe eyelet 30 can provide a rigid structure for suture to engage. Aswill be described herein, the proximal stem portion 28 can be used tointerface with the inserter assembly 12 and can be removed from theremainder of the suture anchor 10 subsequent to insertion of the sutureanchor 10 into bone.

The solid portion 32 of the suture anchor 10 can be formed of anyappropriate biocompatible material including polymers, co-polymers, suchas polyetheretherketone (PEEK), metals, such as titanium, and variousalloys, formed from titanium, cobalt, chromium, etc. The porous portion34 can include stainless steel, titanium, titanium alloys,cobalt-chromium alloys, PEEK, Polyetherketoneketone (PEKK) and othermaterials that are suited for use in a biocompatible environmentincluding Regenerex™, a porous titanium construct manufactured fromTi-6Al-4 V alloy and commercially available from Biomet, Inc., ofWarsaw, indiana. The porous portion 34 can be adapted to receive boneingrowth through interstitial space at ports defined therein.Furthermore, the porous portion 34 includes a rough surface that canfacilitate initial fixation into bone. The porous portion 34 can createenhanced fixation to the bone in a shorter time frame compared to sutureanchors formed exclusively of solid material.

With particular attention now to FIGS. 3-7 , the inserter assembly 12will be further described. The inserter assembly 12 can generallyinclude an impacting portion 60 and a sleeve portion 62. The impactingportion 60 can extend along a longitudinal impacting portion axis 64 andhave a strike plate 66 and a shaft portion 68. The shaft portion 68 candefine a suture engaging surface or blind bore 70 having a terminalengaging surface 72. A first threaded portion 76 can be formed aroundthe shaft portion 68.

The sleeve portion 62 can generally extend between a handle portion 80and a distal suture engaging end 82. The handle portion 80 defines acentral passage 84. The sleeve portion 62 can include a second threadedportion 88 that is configured to threadably mate with the first threadedportion 76 of the impacting portion 60. The distal suture engaging end82 includes a suture engaging member 90. In the example shown, thesuture engaging member 90 is in the form of a hook although othergeometrical configurations suitable for grasping a suture arecontemplated. The suture engaging member 90 defines an opening 92 (FIG.5 ) and a suture nesting slot 94.

As will be described herein, the inserter assembly 12 is movable betweenan alignment position (FIGS. 3 and 4 ), an insertion position (FIG. 5 )and a driven position (FIG. 6 ). In general, the inserter assembly 12can be used to position a suture 100 in a desired location relative tothe eyelet 30 to account for a length 102 (FIG. 5 ) of the suture 100that will be driven into bone 110. Explained further, the sutureengaging member 90 of the sleeve portion 62 can engage the suture 100 atan offset position (FIG. 5 ) relative to the eyelet 30 to define thelength 102 of the suture 100 that will be pulled into bone 110. Becausethe length 102 of the suture 100 has been accounted for prior to drivingthe suture anchor 10 into the bone 110 (FIG. 5 ), the suture 102 willnot be over-tightened on tissue 112 as a result of advancing the sutureanchor 10 into the bone 110 (FIG. 6 ).

An exemplary method of securing the soft tissue 112 to the bone 110using the suture securing assembly 14 will now be described. Initially,the suture anchor 10 can be positioned with respect to the inserterassembly 12. In one example, the proximal stem portion 28 of the sutureanchor 10 can be inserted into the blind bore 70 of the shaft portion 68of the inserter assembly 12. The proximal stem portion 28 can be furtheradvanced until a terminal proximal end 114 of the proximal stem portion28 engages or bottoms out onto the engaging surface 72 (FIG. 3 ).Additionally or alternatively, the proximal stem portion 28 can beadvanced into the blind bore 70 until a distal engaging end 116 (FIG. 3) on the shaft portion 68 engages a proximal engaging surface 118 on thesuture anchor 10. In one configuration, the long axis 22 of the sutureanchor 10 is coaxial with the impacting portion axis 64.

The suture 100 can then be threaded through the eyelet 30. It will beappreciated that the suture 100 may have been threaded through theeyelet 30 prior to advancing the proximal stem portion 28 into the blindbore 70. Next, the suture engaging member 90 is hooked around the suture100 (FIGS. 3 and 4 ). In some examples, the suture 100 may be threadedthrough the eyelet 30 and the suture nesting slot 94 in one motion. Atthis point it is important to recognize that the strike plate 66 isoffset from the sleeve portion 62 a first distance 120 (FIG. 4 ).

The distal tip 24 can be initially advanced slightly into the bone 110as shown in FIG. 5 . With the suture engaging member 90 hooked aroundthe suture 100, the sleeve portion 62 is rotated around the impactingportion axis 64 causing the sleeve portion 62 to move upwardly (asviewed from FIG. 4 ) relative to the impacting portion 60. Specifically,the first and second threaded portions 76 and 88 cooperate to permit thesleeve portion 62 to move from the alignment position (FIG. 4 ) to theinsertion position (FIG. 5 ). Notably, as the first distance 120 closes,the suture engaging member 90 moves a second distance 122 upward andaway from the distal tip 24. As the sleeve portion 62 translates upward,the suture engaging member 90 slidably negotiates along the suture 100.In the example provided, the first distance 120 is substantiallyequivalent to the second distance 122. While the exemplary mechanicalconfiguration described herein includes cooperating threaded portions 76and 88, other configurations are contemplated for providing relativemovement between the sleeve portion 62 and the impacting portion 60.Moreover, while the above description identifies the sleeve portion 62as being rotated, it will be appreciated that one or both of the sleeveportion 62 and the impacting portion 60 can be rotated to cause relativemovement therebetween.

According to one exemplary method, once the inserter assembly 12 is inthe insertion position (FIG. 5 ) and the length 102 of suture 100 isaccounted for, the suture 100 can be tightened relative to the tissue112. As explained above, because the length 102 of the suture 100 iscreated, driving the suture anchor 10 into the bone 110 will not furthertighten the suture 100 on the tissue 112. The inserter assembly 12 canthen be used to drive the suture anchor 10 into the bone 110 (FIG. 6 ).In one example, the strike plate 66 is impacted such as with animpacting tool (not shown) causing an impacting force to be communicatedfrom the engaging surface 72 of the shaft portion 68 to the sutureanchor 10 such as on the terminal proximal end 114 of the proximal stemportion 28. The strike plate 66 may be impacted one or many times untilthe inserter assembly 12 reaches the driven position (FIG. 6 ) and thesuture anchor 10 is driven into the bone 110. After the suture anchor 10has been driven into the bone 110, the sleeve portion 62 can be rotateduntil the suture engaging member 90 releases the suture 100 as depictedin FIG. 7 . The inserter assembly 12 can then be removed from the sutureanchor 10. The proximal stem portion 28 can then be cut off or otherwiseremoved from a remainder of the suture anchor 10.

With reference now to FIGS. 8-11 , a suture anchor 210 constructed inaccordance to additional features of the present disclosure will bedescribed. The suture anchor 210 can be provided together such as in akit with an insertion tool 212 as a suture securing assembly 214.Alternatively, the suture anchor 210 and the insertion tool 212 may beprovided separately and do not require each other for operation.

The suture anchor 210 generally comprises an anchor body 220 thatextends along a longitudinal anchor body axis 222. The anchor body 220can include a distal tip portion 224, and a proximal body portion 226.The proximal body portion 226 can have a proximal terminal end surface228. An eyelet 230 can be formed through the proximal body portion 226.In the example shown, the eyelet 230 has a substantially oval shapehowever other configurations are contemplated.

The anchor body 220 can include a solid anchor portion 232 and a porousanchor portion 234. The solid and porous anchor portions 232 and 234 canbe formed from the materials described above with respect to the sutureanchor 10. The anchor body 220 can further define a first longitudinalopening 240, a second longitudinal opening 242 and a central opening244. The first and second longitudinal openings 240 and 242 connect withthe eyelet 230 (FIG. 9 ). In one example, the eyelet 230, the firstlongitudinal opening 240, the second longitudinal opening 242 and thecentral opening 244 are all formed in the solid anchor portion 232 forincreased strength.

The insertion tool 212 can include an insertion tool body 250 and aninserter tip 252. The inserter tip 252 can define an increased diameterportion 254 configured to provide a friction fit with the centralopening 244. The insertion tool 212 can further include longitudinalslits 260 that run along the inserter tip 252 and a portion of theinsertion tool body 250. As will be described, the longitudinal slits260 provide a pathway to accommodate suture extending out of either thefirst or second longitudinal openings 240 and 242 (FIG. 10 ).

With particular attention now to FIGS. 9 and 10 , an exemplary method ofusing the suture anchor 210 will be described. The suture anchor 210 isparticularly versatile as it can be used for either primary fixation(solid suture 300, FIG. 9 ) or secondary fixation (phantom suture 300,FIG. 9 ). In this regard, the eyelet 230 can be used to receive suture300 when used for secondary fixation. Those skilled in the art willrecognize that secondary fixation is a knotless fixation where a portionof the suture 300 may be pinched between an inner diameter of the bonehole and an outer circumference of the suture anchor 310. When thesuture anchor 210 is used for secondary fixation, one of the first andsecond longitudinal openings 240 and 242 can be used to thread thesuture 300 and the suture 300 can extend out of the eyelet 230 (phantomview suture 300, FIG. 9 ).

As viewed in FIG. 9 , in one method, the suture (represented as solidline 300) can be threaded down one of the first and second longitudinalopenings 240 and 242, to the eyelet 230 and up the other of the firstand second longitudinal openings 240 and 242. In another method, thesuture (represented as phantom line 300) can be threaded down one of thefirst and second longitudinal openings 240 and 242 and out the eyelet230. In either scenario, one end of the suture 300 that extends out fromthe proximal terminal end surface 228 will be free. In this regard, thesuture 300 is free to slidably negotiate out of the first longitudinalopening 240 during driving of the suture anchor 210 into the bone.Further, a desired amount of tension can be applied to the suture 300relative to the tissue 312. Over-tightening of the suture 300 around thetissue 312 as a result of driving the suture anchor 210 into the bonecan be avoided.

In FIG. 10 , the leftmost anchor 210 is shown with the suture 300threaded for use in primary fixation. The rightmost anchor 210 is shownwith the suture 300 in solid line threaded for primary fixation oralternately for secondary fixation (phantom line). In FIG. 11 , therightmost anchor 210 is shown with the suture 300 threaded through thefirst and second longitudinal openings 240 and 242 for use in primaryfixation. The leftmost anchor 210 is shown with the suture 300 threadedthrough the first longitudinal opening 240 and between an outer diameterof the suture and an inner diameter of the bone 310 for use in secondaryfixation.

With reference now to FIGS. 12, 13 and 16 , a suture anchor 410constructed in accordance to additional features of the presentdisclosure will be described. The suture anchor 410 can be providedtogether such as in a kit with an insertion tool 412 (FIG. 16 ) as asuture securing assembly. Alternatively the suture anchor 410 and theinsertion tool 412 may be provided separately and do not require eachother for operation.

The suture anchor 410 generally comprises an anchor body 420 thatextends along a longitudinal anchor body axis 422. The anchor body 420can include a distal tip portion 424, and a proximal body portion 426.The proximal body portion 426 can have a proximal terminal end surface428. An eyelet 430 can be formed through the proximal body portion 426.In the example shown, the eyelet 430 has a substantially oval shapehowever other configurations are contemplated.

The anchor body 420 can include a solid anchor portion 432 and a porousanchor portion 434. The solid and porous anchor portions 432 and 434 canbe formed from the materials described above with respect to the sutureanchor 10. The anchor body 420 can further include a pair of flexiblewing portions 436 extending outwardly from the anchor body 420. Theflexible wing portions 436 can be configured to contract duringinsertion and provide a radially outwardly biasing force ontosurrounding bone once inserted to inhibit withdrawal of the sutureanchor 410 from the bone. A central opening 438 can be formed in theproximal terminal end surface 428.

The eyelet 430 can be formed through the anchor body 420 from a firstopening 440 at the proximal end surface 428 to a second opening 442through an outer cylindrical wall of the anchor body 420. In oneexample, the first opening 440 can extend through one of the flexiblewing portions 436. In one example, the eyelet 430 and the flexible wingportions 436 are all formed in the solid anchor portion 432.

One method of using the suture anchor 410 will now be described. Asuture 500 can be threaded into the first opening 440 and out of thesecond opening 442. Because the first opening 440 extends out throughthe proximal terminal end surface 428, the suture 500 will not bepinched between the anchor body 420 and the inner diameter of the bonehole during insertion of the suture anchor 410. In this regard, an endof the suture 500 extending out of the first opening 440 is free toslide during insertion of the suture anchor 410 into the bone hole.Similar to the function of the longitudinal openings 240 and 242 of thesuture anchor 310, a free end of the suture 500 can precludeover-tightening of the suture anchor 410 during insertion into bone. Asa result, the suture anchor 410 can be particularly useful for secondaryfixation.

The insertion tool 412 can include an inserter tip 470 configured to bereceived into the central opening 438 of the suture anchor 410. A raiseddiameter portion 472 can be in the form of an elastomeric member oro-ring. The raised diameter portion 472 can be configured to attain afriction or interference fit with the central opening 438. Anotherinsertion tool 480 shown in FIG. 14 can include an inserter tip 482 anda handle 484. The handle 484 can be connected to the inserter tip 482 bya shaft 486. Another insertion tool 512 shown in FIG. 15 includes aninsertion tip 514 having a raised diameter portion 516. The raiseddiameter portion 516 can be in the form of an elastomeric member oro-ring. The raised diameter portion 516 can be configured to attain afriction or interference fit with the central opening 244 or 438.Another insertion tool 532 shown in FIG. 17 includes an insertion tip534 having a raised diameter portion 536. The raised diameter portion516 can be in the form of an elastomeric member or o-ring. The insertiontip 534 can include a pointed distal end 540 configured to extendthrough an anchor.

While one or more specific examples or aspects have been described andillustrated, it will be understood by those skilled in the art thatvarious changes may be made and equivalence may be substituted forelements thereof without departing from the scope of the presentteachings as defined in the claims. Furthermore, the mixing and matchingof features, elements and/or functions between various examples may beexpressly contemplated herein so that one skilled in the art wouldappreciate from the present teachings that features, elements and/orfunctions of one example may be incorporated into another example asappropriate, unless described otherwise above. Moreover, manymodifications may be made to adapt a particular situation or material tothe present teachings without departing from the essential scopethereof.

The terminology used herein is for the purpose of describing particularexample implementations only and is not intended to be limiting. As usedherein, the singular forms “a,” “an,” and “the” may be intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. The term “and/or” includes any and all combinations of one ormore of the associated listed items. The terms “comprises,”“comprising,” “including,” and “having,” are inclusive and thereforespecify the presence of stated features, integers, steps, operations,elements, and/or components, but do not preclude the presence oraddition of one or more other features, integers, steps, operations,elements, components, and/or groups thereof. The method steps,processes, and operations described herein are not to be construed asnecessarily requiring their performance in the particular orderdiscussed or illustrated, unless specifically identified as an order ofperformance. It is also to be understood that additional or alternativesteps may be employed.

1. (canceled)
 2. A method of delivering a suture anchor into a bone, themethod comprising: locating an anchor inserter assembly adjacent to abone with a suture anchor removably coupled to a distal portion of theanchor inserter assembly and with a suture extending through an eyeletof the suture anchor and engaging a suture engaging member of the anchorinserter assembly; moving the suture engaging member in a proximaldirection relative to a longitudinal axis of the anchor inserterassembly following said locating, wherein, during said moving, thesuture remains extending through the eyelet and the suture engagingmember slides along the suture; tensioning a first length of the suturebetween the suture engaging member and the eyelet; advancing the sutureanchor into the bone; and disengaging the suture from the sutureengaging member.
 3. The method of claim 2, wherein said moving comprisestranslating a sleeve portion of the anchor inserter assembly relative toan impacting portion of the anchor inserter assembly that is contactinga proximal portion of the suture anchor, the suture engaging memberincorporated along a distal section of the sleeve portion.
 4. The methodof claim 3, wherein the sleeve portion and the impacting portion arethreadably engaged.
 5. The method of claim 2, wherein said tensioningoccurs after said moving and prior to said advancing.
 6. The method ofclaim 2, wherein the suture engaging member comprises a hook.
 7. Themethod of claim 2, wherein the suture anchor comprises a removable stemportion over which the anchor inserter assembly is received.
 8. Themethod of claim 7, wherein the removable stem portion is receivable inan impacting portion of the anchor inserter assembly.
 9. The method ofclaim 8, wherein the anchor inserter assembly includes a sleeve portionthat incorporates the suture engaging member, the impacting portionreceivable in the sleeve portion.
 10. A method of delivering a sutureanchor into a bone, the method comprising: locating an anchor inserterassembly adjacent to a bone with a suture anchor removably coupled to adistal portion of the anchor inserter assembly and with a sutureextending through an eyelet of the suture anchor and engaging a sutureengaging member of the anchor inserter assembly; moving a first portionof the suture away from the eyelet with the suture engaging member,wherein said moving leaves a length of suture extending distally fromthe suture engaging member to the eyelet; advancing the suture anchorinto the bone; and disengaging the suture from the suture engagingmember.
 11. The method of claim 10 further comprising tensioning thesuture between the suture engaging member and the eyelet after saidmoving and prior to said advancing.
 12. The method of claim 10, whereinsaid moving comprises translating a sleeve portion of the anchorinserter assembly relative to an impacting portion of the anchorinserter assembly that is contacting a proximal portion of the sutureanchor, the suture engaging member incorporated along a distal sectionof the sleeve portion.
 13. The method of claim 10, wherein the sutureanchor comprises a removable stem portion over which the anchor inserterassembly is received.
 14. The method of claim 13, wherein the removablestem portion is receivable in an impacting portion of the anchorinserter assembly.
 15. The method of claim 14, wherein the anchorinserter assembly includes a sleeve portion that incorporates the sutureengaging member, the impacting portion receivable in the sleeve portion.16. The method of claim 15, wherein the sleeve portion and the impactingportion threadably engage one another.
 17. A method of delivering asuture anchor into a bone, the method comprising: loading a suturethrough an eyelet of a suture anchor that includes a distal tip;coupling the suture anchor to an anchor inserter assembly comprised of asleeve portion and an impacting portion; engaging the suture with asuture engaging member of the anchor inserter assembly at a locationadjacent to the eyelet; translating the sleeve portion and the impactingportion relative to one another to thereby move the suture a firstdistance offset from the eyelet in a direction away from the distal tip;advancing the suture anchor into the bone; and disengaging the sutureengaging member from the suture.
 18. The method of claim 17 furthercomprising applying a desired amount of tension to the suture subsequentto said translating and prior to said advancing.
 19. The method of claim18, wherein said advancing advances the suture anchor into the bone asecond distance, the first distance and the second distance beingsubstantially equivalent such that the desired amount of tension on thesuture is substantially maintained following said advancing.
 20. Themethod of claim 17, wherein said translating comprises threadably movingthe sleeve portion and the impacting portion relative to one another.21. The method of claim 17, wherein said translating causes the sutureengaging member to slidably engage the suture.